197603807-6-25-2021-31-AS-NMAN-C6PKPE-20210909080436

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603807
Report Date: 06/25/2021
Date Signed: 06/25/2021 06:29:49 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/23/2021 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20210623114521

FACILITY NAME:	SUNRISE AT STERLING CANYON		FACILITY NUMBER:	197603807
ADMINISTRATOR:	JOHNSON, MICHELLE M		FACILITY TYPE:	740
ADDRESS:	25815 MCBEAN PKWY		TELEPHONE:	(661) 253-3551
CITY:	VALENCIA	STATE: CA	ZIP CODE:	91355
CAPACITY:	140	CENSUS: 113	DATE:	06/25/2021
		UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Tammy Berry - Executive Director		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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9

Admission agreement does not identify itemized description of charges for resident(s) services.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Gary Tan and LaQueena Lacy conducted an unannounced complaint visit to this facility to investigate the above allegation. LPAs met with Executive Director Tamara Berry and explained the reason for the visit.

LPAs conducted physical plant tour at 9:20 AM. At 9:35, LPAs requested copies of pertinent documents relevant to the investigation. At 11:45 AM, LPAs interviewed staff and Executive Director of the facility. Based on LPAs record review, the admission agreement contained all the details of the potential charges the resident may need depending on the level of care with the corresponding price for each services. Further, LPAs review of Resident #1 (R1)'s record also revealed that R1 had a periodic Indivualized Care Plan signed by the Power of Attorney (POA) of R1. Based on the information gathered during this visit, the allegation is deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 06/25/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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